Provider Demographics
NPI:1316401722
Name:BROWN, JENNIFER DIANNA (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANNA
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3025
Mailing Address - Country:US
Mailing Address - Phone:360-425-7712
Mailing Address - Fax:
Practice Address - Street 1:1639 KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8912
Practice Address - Country:US
Practice Address - Phone:360-880-0457
Practice Address - Fax:360-326-2648
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61028188363LF0000X
WARN00161955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse